Sexual health–a Health of the Nation failure

The Health of the Nation initiative was launched five years ago in July 1992 with the publication of a white paper. 1 The five key areas-coronary heart disease and stroke, cancers, mental illness, accidents, and HIV/ AIDS and sexual health-were given priority and specific objectives, and targets were set.For HIV/AIDS and sexual health the objective was to reduce the incidence of HIV infection and of other sexually transmitted diseases, with specific targets related to gonorrhoea and conceptions among teenagers.These specific targets were to reduce the incidence of gonorrhoea among men and women aged 15-64 years by at least 20% by 1995 (from 61 new cases per 100 000 population in 1990 to no more than 49) and to reduce the rate of conceptions among girls aged under 16 by at least 50% by the year 2000 (from 9.5 per 1000 girls aged 13-15 in 1989 to no more than 4.8).A closer examination of the incidence of sexually transmitted diseases, HIV infection, and conception rates suggests that there is still a long way to go. The targets GonorrhoeaAlthough the target for gonorrhoea has been achieved ahead of time (fig 1), the incidence was declining so rapidly before the target had been defined, and continued to do so afterwards, that it was almost certain to continue declining without any new initiatives.The decline was therefore probably a poor indicator of effective health promotion and improved service delivery by departments of genitourinary medicine.Caution is needed when claiming success for the Health of the Nation programme.New cases of gonorrhoea among homosexual men have not shown a rapid decline (fig 2). 2 Cases of gonorrhoea seen in genitourinary medicine clinics in the Thames regions, reported as acquired through homosexual contact, declined in 1992 and 1993 but rose by 26% in 1994 and by a further 9% in 1995.Outside the Thames regions, levels have remained fairly stable.Some cases of gonorrhoea will be acquired through non-rectal and "safe sex"-namely, orogenital contact-and thus the number of cases of gonorrhoea alone, without site of infection, may mask adoption of safer sex practices.However, the numbers of cases of genital warts, chlamydial infections, and herpes also acquired through homosexual intercourse have not declined markedly between 1990 and 1994.The number of cases of genital warts increased in the Thames regions between 1990 and 1995 by almost 50%, from 572 to